UOBCOM | 98 | Quizzes

SurgeryM - Thoracic - Explaination lec 8 Video 1 Video 2

SurgM - Thoracic - Lec 8 Explanation By : @Mi818sh

Notes-surgery(uro)8 By: @mo_0_8_0

Antiarrhythmic drugs part 1 Part 2

SM - cardiology  / cardiomyopathy شرح ماستر كلاس

عله ديفيدسون

*ملزمه الكليه معظمها ديفدسون

ملزمه هيثم نبيل

اول موضوع مو ضمن ملزمتنا بس شوفوا

ملفات كيسات وزاريه من.سادسه

تفيد تعرفون شلون يجي السؤال وتفسير الإجابات وتوضيحات عامه عن الكيس ينصح به

SM - cardiology lec 15 Cardiomyopathy By: @Ali_syo0

فورمتف الكارديو لتنسوا

Surgery - general Pancreas and pancreatic cancer (18 + 19) By: easy surgery with zaid

Pancreas surgery Pancreatic Cancer

Surgery - general Stomach and duodenum (11-12-13) By: easy surgery with zaid

ف سكرنوا ايشي مموجود ولزكوا بالملزمة دا احجي ع الشرح الاول وليس شرح هايمد

اكللكم ترة هاي الفيديوات اتصور على ملازم كليتنا القديمة لان بيها كل كل ملاحظات الدكتور حتى الما موجودة بملازمنا (مطلوبات ورح يجون)

PUJO short PUV short Overview قبل المحاضرة PUJO PUV ————————— PUJO شرح آخر هايمد من دقيقة 21:30 PUV شرح آخر هايمد من دقيقة 17

SurgM-Urology lecture 8 (Pelvi-Ureteric Junction Obstruction and Posterior Urethral Valves)

PUJO short PUV short Overview قبل المحاضرة PUJO PUV ————————— PUJO شرح آخر هايمد من دقيقة 21:30 PUV شرح آخر هايمد من دقيقة 17

SurgM-Urology lecture 8 (Pelvi-Ureteric Junction Obstruction and Posterior Urethral Valves)

Heart Failure > Goals of treatment: 1. Alleviate symptoms 2. Slow disease progression 3. Improve survival > Therapeutic strategies 1. Reduction in physical 2. Low dietary intake of sodium 3. Treatment of comorbidities 4. Drugs > Drugs that may precipitate HF 1. NSAIDs 2. Alcohol 3. CCB 4. Some anti-arrhythmatics Drugs 1. Inhibitors of Renin-Angiotensin system 1- ACE inhibitors > Reduce preload and afterload > For HFrEF (Low ejection fraction) > Recent MI > Should be taken on empty stomach 2- ARBs > Taken once daily except for valsartan taken twice > Candesartan have low volume of distribution > Losartan undergoes first pass effect 3- Aldosterone antagonist > Spironolactone > For MI and HFrEF > May cause hypokalemia 2. Beta-Blockers > Initial exacerbation of symptoms > Avoid using for CCB > Use at low doses > Slow cardiac remodelling and cell death > Bisoprolol, Metoprolol, Carvedilol 3. Diuretics > Mainstay treatment > Reduce edema > Loop diuretics are most commonly used 4. ARNI > Sacubitril/Valsatran > Block action of angiotensin and enhance function of natriuretics > Decrease afterload, preload and myocardial fibrosis > Replace ACEI and ARBs when they are ineffective > Stop ACEI atleast 36 hours before starting ARNI 5. HCN (Ivabradine) > Used when heart rate is above 70 beats per minute > Adverse effects: Bradycardia, Incraese risk of AF, luminous phenomena > C/I: Pregnancy, Breast-feeding, more advanced heart block, 3A4 inhibitors 6. Direct vaso and veno dilators > Nitrates > Hydralazine > Decrease cardiac preload and afterload > Use when patient is intolerant to ACE inhibitors and BB > Adverse effects: Headache, Hypotension, Tachycardia 7. Inotropic drugs > Associated with decreased survival so only used for short periods of time and inpatient settings (digoxin may be used for longer) 1- Digitalis glycosides > Digoxin > Inhibit ATPase enzyme من اكو صوديم برة الخلية تكدر تطببه و تطلع الكالسيوم اذا الصوديوم بقه جوه الخلية مراح تكدر تطلع الكالسيوم فالكالسيوم راح يزيد داخل الخلية و الcontractility تزيد > Incraese the risk of arrhythmia > Increases vagal tone so HR and Myocardial demand decreases > Slows conduction through AV > Useful for AF > Inhibits sympathetic activation (low-dose) > For patients with diastolic or right sided heart failure when there is AF and atrial flutter > Adverse effects: Undesirable effects on CNS and gut, Anorexia, Nausea, Vomitting, Blurred vision, yellowish vision, VT > Use with caution with BB and CBB 2- Beta adrenergic agonists > Dobutamine > Increase cAMP > Incraese phosphrylation of calcium channels, increase entry of CA2+ > Used in acute HF 3- Phosphodiesterase inhibitors > Milrinone > Long-term use is associated with increased mortality 8. Recombinant B-type Natriuretic Peptide > In acute decompensated congestive HF > Nesiritide as bolus or continuous infusion > Short half life > Adverse Effects: Hypotension, Dizziness, Worsen renal function Order of treatment: Diuretic > ACE/ARBs > BB > Aldosterone antagonist, hydralazine, isosorbide dinitrate > Switch to ARNI > Digoxin

Anti-anginal drugs > 7 groups 1- Beta-Blockers • Reduce oxygen demands of heart • Compelling indications: Heart failure with reduced ejection fraction and hypertension • Avoid: > Asthma (non-selective) > Vasospastic Angina > Pindolol in MI (Has intrinsic sympathomimetic activity) > Avoid in severe bradycardia 2- CCB • Prevents calcium influx thus preventing the stimulation of many enzymes that use up energy stores and worsen ischemia • Useful in vasospastic angina because it prevents vasoconstriction • Avoid verapamil in patients with depressed cardiac function and AV conduction abnormality 3- Organic nitrates • Useful in all types of angina • They are converted to nitrate ions and then to NO, NO activates guanylate cyclase and increases cGMP, cGMP leads to dephosphorylation of the myosin light chain resulting in vascular smooth muscle relaxation • Veno and arterio dilator > Reduces preload and afterload > reduces myocardial oxygen demand • Sublingual with rapid onset of action • Adverse effects: Headache, postural hypotension, facial flushing, tachycardia • C/I: combination with phosphodiesterase type 5 inhibitor • Subject to tolerance, so provide nitrate free interval 4- Potassium channel activator • Nicorandil • Veno and arterio dilator • Less effect on HR, BP, contractility • Given orally 5- Sodium channel blocker • Ranolazine • For chronic angina • Used for patients who have failed other antianginal drugs • Inhibition of late I Na current, improving diastolic function 6- Ivabradine • Inhibition of IF current in SA node > Reduced HR > Useful combination with BB in elevated HR 7- Trimetazidine • Cytoprotective anti-ischemic agent • Inhibits beta oxidation by blocking long chain 3 ketoacyl-CoA thiolase which enhances glucose oxidation, this optimizes cellular energy processes maintaining proper energy metabolism durinh ischemia, insuring functioning pumps • Used for tinnitus and dizziness